Hepatitis

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Hepatitis is an inflammation of the liver, normally caused by a viral infection (but also sometimes from toxic exposures to alcohol or certain drugs or chemicals). The condition can cause cell damage and destruction in the liver, an organ essential for health and survival. It can occur in an acute form with very marked symptoms over a short period of time or in chronic form when milder symptoms persist longer than six months and up to years. Often, chronic cases are in people who have not recovered fully from acute hepatitis, and whose liver thus continues to sustain more damage and inflammation.

Identifying all of the viruses and virus subtypes that contribute to hepatitis is an ongoing area of study; however, six main types of hepatitis disease are known, each caused by different viruses (and named for them), and collectively treated in many millions of people worldwide. Types A, B, and C are most common in the U.S.

Hepatitis A is so easily transmitted, in households or in public places such as restaurants and preschools, that it was previously referred to as "infectious hepatitis." Many infected individuals have few or no symptoms. Many others develop acute hepatitis, but this virus does not cause chronic hepatitis. A vaccine is available against this form of hepatitis.

HepatitisB is also one of the most frequently reported, vaccine-preventable diseases in the U.S. It is estimated that approximately 1.2 million people in the U.S. suffer from chronic hepatitis B infection. Many infected individuals have few or no symptoms. The vaccine for hepatitis B is now widely used in child, adolescent, and young-adult vaccination.

Hepatitis C (previously referred to as non-A, non-B hepatitis) usually produces mild symptoms at first with a gradual onset of more severe symptoms and chronic liver disease in a majority of people who are infected. According to the Centers for Disease Control and Prevention (CDC), hepatitis C is the leading indication for liver transplantation. With some cases of hepatitis C, no mode of transmission can be identified. In addition, people with alcoholic liver disease also tend to develop hepatitis C. The virus responsible for this disease causes approximately 25,000 new infections in the U.S. each year. There is no vaccine for hepatitis C at this time.

Hepatitis D, E, F, & G.

Hepatitis D can only occur in the presence of hepatitis B. If an individual has hepatitis B and does not show symptoms, or shows very mild symptoms, infection with D can put that person at risk for full-blown liver failure that progresses rapidly. Hepatitis D can occur at the same time as the initial infection with B, or it may show up much later. There is no vaccine for hepatitis D at this time.

Hepatitis E is similar to hepatitis A. It is rarely seen in the United States, being more common in poorly developed countries. There is no vaccine for hepatitis E at this time.

Hepatitis F is another suspected type of hepatitis but a virus has not been confirmed for it yet.

Hepatitis G is caused by newly identified strain of hepatitis virus, and very little is known about it. Often, hepatitis G shows no clinical symptoms. There is no vaccine for hepatitis G at this time.

Sometimes other types of viruses that may not primarily attack the liver, such as those that cause for mononucleosis, can nevertheless cause hepatitis.

Causes/risk factors

Each form of hepatitis has its most likely routes of transmission, but most have at least the possibility of more than one mode of transmission. To become infected, a person's mucus tissue (including in the GI system) or blood stream must come in contact with virally contaminated bodily fluids (blood, semen, vaginal secretions, or saliva), food, or liquid. In general hepatitis viruses are passed though the following routes:

consuming food made by someone who touched infected feces;

drinking water that is contaminated by infected feces (a problem in developing countries with poor sewage removal);

oral transmission to self after touching an infected person's feces,

oral-to-oral or sexual contact with an infected person;

or participation in high-risk activities such as unprotected heterosexual or homosexual sexual contact or intravenous (IV) drug use.

Infants may also develop the disease if they are born to a mother who has the virus. In addition, infected children often spread these viruses to other children if there is frequent contact or a child has many scrapes or cuts. Outbreaks may occur in large childcare centers, especially when there are children in diapers, or across ethnic communities where hepatitis may be more common, including those made up of people who have immigrated from China or other parts of Southeast Asia.

Others who are at risk include those work in healthcare professions; who live in long-term care facilities; who have been treated for a blood clotting disorder such as hemophilia; who require dialysis for kidney failure; or who received a blood transfusion before 1992. (Today, Blood products used for transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.) Many cases of hepatitis, though, come from unknown sources.

Hepatitis can also result from an overdose of drugs (such as acetaminophen) or significant exposure to certain chemicals (such as dry cleaning fluids). Chronic hepatitis can also be due to heavy alcohol consumption; an autoimmune disorder (when the body attacks its own tissues); reaction to certain medications; or a metabolic disorder (such as hemochromatosis or Wilson's Disease).

Signs & symptoms

Hepatitis can produce flu-like symptoms among other signs. Most commonly, this means some combination of:

jaundice;

nausea;

vomiting;

loss of appetite;

fever;

fatigue;

tenderness in the right, upper abdomen;

sore muscles;

joint pain;

and itchy red hives on skin.

Symptoms can be mild, and progression can be slow in non-acute cases.

Diagnosis

In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose hepatitis:

liver function tests to measure liver enzymes in blood;

specific laboratory tests, including those to detect viral antibodies, proteins, or genetic material;

liver biopsy (in particular for chronic hepatitis, to determine severity of inflammation, scarring, and cirrhosis, as well as to identify the underlying cause);

or ultrasound to rule out other conditions.

Persons who are at risk should be checked or tested regularly for hepatitis.

However, chronic infection often does need treatment. The goal of treatment is to stop damage to the liver and alleviate symptoms.

Treatment may include:

antiviral agents. When caused by hepatitis B or C, inflammation of the infection may be stopped with the antiviral agent interferon-alpha.

corticosteroids. Corticosteroids may be used to treat chronic liver disease caused by an autoimmune disorder. Inflammation is suppressed, but scarring of the liver may continue.

discontinuation of certain drugs. When chronic hepatitis is caused by certain drugs, symptoms usually resolve when the drugs are discontinued.

antibody preparation. If a person has been exposed to hepatitis, an antibody preparation can be administered to help protect him or her from contracting the disease.

Almost all patients with hepatitis A and most with hepatitis B recover fully. Yet, about five percent of patients with hepatitis B and about 80 percent with hepatitis C develop chronic hepatitis. These patients must be vigilant and prevent transmission to others.

Severe, acute hepatitis (fulminate hepatitis) may require hospitalization. If the liver becomes extensively damaged, liver transplantation my be the only option. Gastroenterologists at Aria Health work in cooperation with Jefferson's Liver Transplant Program to provide patients with advanced liver disease the opportunity for evaluation and transplantation.

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